Phthalates are endocrine disrupting chemicals found in almost every corner of the 21st-century world. Whether you’re already trying to avoid them or have never heard of them, this guide is for you!
This post really does include everything you need to know. If you don’t have time now, there’s an informative infographic at the bottom of the post and you can pin it for later. Otherwise, grab a hot beverage and settle in!
What’s the big deal about endocrine disruption?
Your endocrine system is the hormonal communication system for your body. Hormones tell your body when to get hungry and feel full, when to sleep and when to ovulate. And they also control many developmental stages in the body (fetal growth, puberty, menopause, etc.).
Over the past century, humans have introduced many new chemicals into society. These chemicals give us many life-improving inventions. However, a side effect is that some chemicals can interfere with our hormones. Disrupting the hormonal communication in your body can lead to some pretty serious effects.
These effects are so serious that the UN Environment Program called endocrine disrupting chemicals a global threat and the EPA listed phthalates as chemicals “warranting immediate attention [due to their] toxicity and the evidence of pervasive human and environmental exposure” (Benjamin, et al. 2017).
But what are Phthalates?
Phthalates are used as additives in thousands of consumer products from cars to makeup to medical supplies. There are dozens of different types of phthalates but they can basically be organized into two different classes:
High molecular weight phthalates are used as plasticizers (they make plastic like PVC softer and more pliable) in items such as plastic food packaging, toys, building materials and other consumer products. HMW phthalates are typically found in sediment and household dust.
Low molecular weight phthalates are found in fragrances, personal care products, and medications and are more likely found in the air and inhaled (Ahearn et al. 2013)
What’s dangerous about phthalates is that they are not chemically bonded to the materials they are added to. This means that phthalates are continuously released from products. In fact, even slight changes to heat, light, pH or contact with fats can accelerate the leaching of phthalates (Benjamin et al. 2017).
When we inhale, eat, or otherwise absorb phthalates, they are typically metabolized in the body within 24-48 hours and the metabolites are then excreted in urine (Milosevic, et al 2018). Unfortunately, even in the short time they are in our body, they can still wreak havoc.
Phthalates are estrogenic and anti-androgenic meaning they act like estrogen in the body and inhibit androgens (primarily male hormones) (Huang et al. 2018). While they are in the body, they impact our natural hormone functions. Phthalate metabolites act as “hormone sensitizers” in the body disrupting the hormone highway of your endocrine system (Benjamin et al. 2017).
Although phthalates are metabolized and excreted fairly quickly, one study suggests that being continually exposed could cause phthalates to accumulate in the body (Huang, et al 2018). And honestly, pretty much everyone is affected.
Exposure
Phthalates are nearly ubiquitous in the environment. Phthalates have been found in soil, sediments, drinking water, atmospheric and indoor air, wastewater, and dust (Przybylinska & Wyszkowski 2016). Even though phthalates have only been in use about 70 years, they can be found in humans all over the world. One study published in 2013 showed that all 10 year old children had phthalate metabolites in their urine (Ahearn, 2013). Another study showed that phthalate metabolites were detected in 96% of Americans. It’s a pervasive issue. But it’s not slowing down.
Exposure to phthalates is now estimated at the level of tens of micrograms per gram of body weight per day (Benjamin et al 2017).
That sounds really abstract so what does that actually mean?
If the average 7 year old is about 50 pounds or 22.68 kilograms (22,680 grams) that brings the exposure up to 680,400 micrograms per day or roughly .68 grams if we assume about 30 micrograms per gram of body weight. In contrast, the limit for safe drinking water is 6 micrograms per liter (Benjamin et al 2017) but the average 7 year old is potentially exposed to a hundred thousand times that amount in a single day.
Effects of Phthalates
Male Development
Since Phthalates have estrogenic properties, men (and primarily boys) are especially sensitive to its effects. Basically, phthalates impair normal male development.
Two types of phthalates (DEHP and MEHP) have been found to “significantly inhibit testosterone production” in adult human testis confirming a link between exposure to the phthalate MEHP and low testosterone concentrations (Desdoits-Lethimonier et al 2012 and Huang et al 2012). Numerous studies show that certain phthalates also decrease sperm count, quality, and motility (Benjamin et al 2017, Milosevic et al 2018). Phthalates were also found to be associated with increased DNA damage in sperm (Benjamin et al 2017). This is crucial for any men experiencing infertility or low testosterone.
The effect of phthalates is especially critical during development. One study found that exposure to phthalates results in “profound and irreversible changes in the development of the reproductive tract, especially in males” (Xu et al 2014). “Phthalate syndrome” or “testicular dysgenesis syndrome” is impacted by prenatal exposure to phthalates in the womb. It is characterized by reduced sperm count and quality, an increase in sterility and testicular cancer, undescended testes, cryptorchidism (absence of one or both testes from the scrotum), hypospadias (a birth defect where the urethra is not at the tip of the penis), and reduced anogenital distance (distance between the anus and genitalia) (Benjamin et al 2017). These studies have shown a link between increases in our phthalate exposure and genital malformation in infant boys.
On the contrary, one study found no evidence between phthalate concentration and undescended testis risk but confirmed a significant association between anogenital distance and phthalates (Huang et al 2012). Basically, a shorter distance between the genitals and the anus represents incorrect formation of the genitalia. The same study also found a statistically significant association between phthalate exposure (specifically mono isobutyl phthalate or MPzP) and reduced penis length and width (Huang et al 2012). Boys with pubertal gynecomastia (female-like breasts) also had significantly higher concentrations of phthalates than control subjects (Benjamin et al 2017).
In short, “exposure to phthalates, in general, has feminine effects” (Huang et al 2012).
IQ & Learning Disabilities
Phthalate exposure has also been found to have cognitive effects as well. Exposure to DEHP (Diethylhexyl phthalate) was found to be associated with autism spectrum disorder and low cognitive function (Benjamin et al 2017). Another phthalate, DBP, was strongly associated with ADHD in Korean children and both DEHP and DBP were found to be associated with ADD and learning disabilities in U.S. children 6-15 years old (Benjamin et al 2017). Autism and learning disabilities can be caused or made worse by other factors as well but this study connects the dots between phthalate exposure and cognitive impairment.
Increased phthalate levels were also associated with lower mental development index and psychomotor development index (PDI) in children. PDI scores decreased with increasing phthalate metabolites (MnBP and MiBP) while odds of motor delay increased significantly (Huang et al 2012).
Female Development
In young girls, there was a positive trend observed between low molecular phthalate metabolites (remember, those are the ones often found in personal care products!) and premature breast and pubic hair development. Early puberty, or precocious puberty (starting before 9 years old), has been associated with the development of breast cancer (Huang et al 2012).
In pregnant women, phthalate exposure can have a lasting impact since phthalates can cross the placenta and have been found in umbilical cord blood and serum (Benjamin et al 2017). An increased risk of pregnancy loss was found among women with higher levels of certain phthalates (Huang et al 2012 and Benjamin et al 2017). Phthalate exposure is also associated with shortened pregnancy and decreased head circumference of newborns (Polanska et al 2016). It is especially important for pregnant women to understand the impacts of phthalate exposure since it has a measurable impact on the development and future health of the baby.
Women with higher urinary concentrations of phthalate metabolites also have an increased risk of endometriosis, infertility, low yield oocytes (eggs), and ovarian disease (Benjamin et al 2017). The same study showed that phthalates can cause DNA damage in mammary epithelial cells and phthalate metabolites were detected in 82% of women with breast cancer and were much higher than the control group (Benjamin et al 2017). Phthalates may also prolong menstrual cycles and increase premature menopause (Huang et al 2012). Multiple studies have also shown a link between high phthalate levels and endometriosis with the severity of endometriosis correlated with the exposure levels (Huang et al 2012).
Diabetes & Weight Gain
Phthalates can also have an effect on the hormones that determine our weight. One of the effects of phthalate exposure is insulin resistance and obesity (Benjamin et al 2017). Exposure in utero predisposes glucometabolic dysfunction in adulthood by altering DNA (Benjamin et al 2017). Phthalates disrupt the metabolic processes inducing insulin resistance and increasing the risk for diabetes (Milosevic et al 2018).
The European Union Expert Panel estimated that phthalate exposure might cause up to 53,900 obesity cases and 20,500 diabetes cases in older women (Milosevic et al 2018). Phthalate exposure was also associated with increased body mass and waist circumference (Benjamin et al 2017). The two are so closely linked that one study found that in 12-19-year-old women, Body Mass Index (BMI) and waist circumference increased with quartile increases of mono-ethyl phthalate (MEP) in the body (Huang et al 2012). Reducing exposure to phthalates may go a long way in helping achieve weight goals.
Asthma & Allergies
Multiple studies found that phthalates (particularly high molecular weight phthalates) were associated with increased asthma and allergies (Benjamin et al 2017 and Ahearn 2013). Remember, these high molecular weight phthalates are mostly found in household dust! Although there hasn’t been as much research in this area, people with allergies and asthma might find some relief in reducing phthalate exposure.
Thyroid Disruption
Phthalates also have anti-thyroid properties and have been shown to decrease thyroid function (Huang et al 2018). Urinary MnBP (mono-n-butyl phthalate) levels in pregnant women were significantly associated with decreases in free thyroxin (FT4) and thyroxin (T4) and exposure to DnBP might affect thyroid activity in pregnant women (Huang et al 2012). Another reason why it is so important to reduce phthalate exposure if you are pregnant.
Where is it all coming from?
Building Materials
Phthalates are used to manufacture vinyl flooring, varnish, paint, fiberglass, carpeting, and adhesives that go into everyday building materials for homes, offices, and retailers. Phthalates are also added to flame retardants which can be found in building materials and furniture. In a study of phthalate levels in retail stores, the highest levels of one phthalate, DEHP (di-ethyl hexyl phthalate), were found in a home improvement store (Xu et al, 2014).
This is the hardest category of phthalates to avoid. Honestly, there is not much you can do unless you want to completely change your home and workplace or live outside in a yurt. I try to avoid new furniture or anything that has been treated with flame retardants. And really, it’s more environmentally friendly to get furniture or building materials second-hand anyway!
Cosmetics & personal care products
Personal care products more commonly contain low molecular weight phthalates (which are more likely to be inhaled) (Ahearn 2013). Phthalates are added to preserve fragrance and fix pigments in cosmetics such as perfume, nail polish, lotion, and deodorant. One study showed that urinary metabolite levels increased with the number of personal care products used (Huang et al 2018). Unfortunately, this means that women are disproportionately affected. The average adult woman uses 12 products while the average teen uses 17 according to one study (Harley et al 2016). Even in infants, exposure to lotion, baby powder, and shampoo significantly increased the urinary concentration of multiple phthalates (Sathyanarayana et al 2008).
And it’s not just people who use these products who are affected. Sales clerks who work in cosmetics and perfume departments are also affected. One study showed that in cosmetic sales clerks, there was a 62% increase in urinary phthalate metabolite levels after a work shift in the cosmetics section compared with levels before the shift (Huang et al 2018). In fact, DEP (diethyl phthalate), an extremely volatile phthalate, is found in highest concentrations near the cosmetics sections of stores (Xu et al 2014).
Unfortunately, you often won’t find a phthalate listed as an ingredient in personal care products. If an ingredient is proprietary (meaning it is a company trade secret), they do not have to list it as an ingredient. Often phthalates fall under the ingredient “fragrance”. If a product does not explicitly say “phthalate-free” it probably contains phthalates.
You can also avoid phthalates by making your own products. There are so many recipes online and I prefer the products I make over store bought ones any day (nothing beats my homemade lemongrass mosquito repellant!).
Pharmaceuticals & Medical Equipment
Phthalates are often used in medical supplies to soften plastic and help deliver certain medications. They can be found in medical devices, gloves, plastic tubing (such as IVs and catheters), and intravenous bags (Milosevic et al 2018). In fact, one study showed that flexible tubing is made of up to 70% phthalates (Benjamin et al 2017).
Phthalates are also used in some prescription and OTC medications (and even supplements). The FDA requires companies to disclose all inactive ingredients unless they are proprietary (similar to personal care products). These proprietary ingredients can’t be made public because they are considered “patented delivery mechanisms” (Kelley et al 2012).
Remember that phthalates are used to make plastics softer and fix certain color and scent properties? In medications, they are used to prevent degradation of enzymes, antacids, and probiotics, to reduce stomach acid, minimize aftertastes and make softgels soft (Kelley et al. 2012). The same study reported that phthalates are found in OTC enteric and film coatings and used in “modified release prescription drug formulations” such as extended release or timed release medications.
Food and Food Packaging
Phthalates can migrate into food through PVC tubes (used in the milking process), PVC gloves worn during food preparation, plastic food packaging, canned food and conveyor belts (Wu et al 2017).
Phthalates were also detected in unusual places such as the lids and gaskets of food jars and in food wrapped in paper (due to the ink and adhesive used on the paper) (Cao 2010). In foods wrapped with plastic wrap, the higher the fat content, the greater the migration of phthalates into food (Cao 2010). For example, phthalates leach more into meats, cheeses, and avocado than other fruits and vegetables.
However, since phthalates are broadly in the environment (Przybylinska & Wyszkowski 2016), one study showed that food that has not had contact with plastic (such as vegetables and eggs) still had detectable levels of phthalates (DiBP and DEHP) (Cao 2010).
Consumer Products
Phthalates have been found in countless everyday products including home furnishings, insect repellants (Fromme et al 2002), electronics (Xu et al 2014), shoes, toys, imitation leather (Milosevic et al 2018), baby products, exercise balls, electric cords, shower curtains and mats, mechanical fluids (Benjamin et al 2017), raingear, car parts, inks and glues, and fertilizers (Przybylinska & Wyszkowski 2016).
The wide range of products that contain phthalates may seem like phthalates are impossible to avoid.
The bad news is that it is basically impossible to avoid all phthalates in modern society. The good news is that there are science-backed ways to significantly decrease your exposure!
Evidence-based Solutions
Reduce cosmetics and personal care products
In a study on adolescent girls in California, they were asked to stop using their regular personal care products for 3 days and were instead given alternative products that were free of phthalates. Before the swap, over 90% of participants had detectable traces of phthalates in their urine. After just 3-days, there was an average decline of 27-45% across multiple types of phthalates (Harley et al 2016).
This is a great example of phthalate-filled personal care products directly affecting urinary phthalate levels. Other studies have shown that girls who use more shower gel and shampoo have higher phthalate concentrations and moms using hair dye at home also increase children’s exposure (Wu et al 2017).
The best thing you can do is use fewer personal care products and only choose products that are specifically phthalate-free. It’s absolutely possible to find a wide array of products made without phthalates so you definitely won’t be missing out! It is especially important for kiddos to avoid the dozens of super scented products marketed for children and babies. There are plenty of natural formulations out there that are healthier for the whole family!
Remove Synthetically Scented Products
In the study on California adolescents, one of the conclusions was that phthalate levels may not have decreased as rapidly because the participants were still exposed to other sources of phthalates including air fresheners, fabric softeners, and cleaning products (Harley et al 2016).
Since certain phthalates help preserve scents, they are almost always found in synthetic fragrances. But remember, this is one that you won’t typically find on the ingredient list! Avoid scented candles, air fresheners (plug-ins and sprays), conventional fabric softener, dryer sheets, convention cleaning products, and “scented” items (tampons, garbage bags, etc.).
Instead, you can replace those items with beeswax candles, homemade essential oil sprays (or a diffuser), and natural cleaning and laundry products. I promise once you make the switch you will never go back and you can rest easy knowing that your family is healthier!
For more tips on how to make your home smell amazing (without phthalates) check out this post.
Reduce Food Packaged in Plastic
A lot of food comes packaged in plastic. Think about it – frozen corn, a rotisserie chicken, a bag of chips, and yogurt all exclusively come in plastic! It’s not just processed food either. Fresh veggies today come in plastic bags, clamshell boxes, and plastic mesh. Even being as aware of it as I am now, I still have to re-evaluate my plastic packaged food addictions every now and then.
Limiting foods packaged in plastic can go a long way in reducing exposure. In one study, eating fresh food with limited packaging reduced phthalate (specifically DEHP) urine concentrations in Taiwanese girls (Chen et al 2015).
Also, avoid using plastic cups, utensils, and storage containers for food and beverages. In the study on Taiwanese girls, limiting drinking beverages from plastic cups reduced urinary levels of multiple phthalates (including MBP, MEHHP, MEOHP, and MECPP) (Chen et al 2015). Use real cups and non-plastic food storage containers.
It is absolutely possible to buy food and avoid plastic packaging. Check out my post on Zero-Waste shopping guide to find out how you can reduce plastic packaging. It’s better for your health and the environment.
Clean Your Home
This was definitely surprising to me but cleaning can reduce phthalate exposure in your home!
Changing children’s bedding (especially pillowcases) frequently (more than once a week) was correlated with substantially lower phthalate levels (Liao et al 2018).
The study also found that sweeping and dusting surfaces in a child’s room more than 3 times a week reduced phthalate levels in children (Liao et al 2018).That’s 3 times more often than I want to dust but this gives you a chance to break into your natural phthalate-free cleaning products!
Reduce Plastic Toys
Having a higher proportion of plastic toys (more than 65% of total toys) was associated with higher phthalate levels in children (Liao et al 2018). Plastic toys (especially soft plastics) can leach phthalates into the surrounding environment.
Try to find toys that are made of wood, metal, ceramic, cloth, etc. I remember having a set of plain (not painted) wooden blocks in dozens of different sizes and shapes and they were by far my favorite toys as a kid! Of course if you walk into any Toys R Us store you are going to find a ton of plastic. Check out alternative stores online, local sellers on etsy, or craft fairs for non-plastic toys.
Even better, have your kid play outside! Outdoor physical activity can accelerate excretion of phthalate metabolites in children (Wu et al 2017).
Phthalates are everywhere in the environment but that doesn’t mean we don’t have the power to reduce our exposure. The use of phthalates is only growing because there is consumer demand for them. And we are the consumers! We can choose whether to keep bringing phthalates into our lives. It’s absolutely possible to reduce our exposure to phthalates and keep our families and communities safer and healthier!
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